The Prevalence and Symptom Profile of Asthma–COPD Overlap: The HUNT Study

The concept of asthma and COPD as separate conditions has been questioned, and the term asthma–COPD overlap syndrome has been introduced. We assessed the prevalence, symptoms, and lifestyle factors of asthma–COPD overlap (ACO) in a large Norwegian population-based study.

From 2006 to 2008, a total of 50,777 residents of Nord-Trøndelag participated in the Nord-Trøndelag Health Study, Norway. They completed questionnaires regarding respiratory symptoms, disease status, and medication use. We estimated the prevalence and 95% confidence intervals of ACO. Additionally, spirometry was used to estimate the prevalence of ACO in a subgroup.

The prevalence of self-reported ACO was 1.9%, and in age groups <40, 40–60 and ≥60 years it was 0.7%, 1.4%, and 3.2%, respectively. Among those reporting COPD, the proportion of ACO was 0.56. In the spirometry subgroup when ACO was defined as doctor diagnosed asthma ever and FEV₁/FVC < 0.70, the prevalence of ACO was 2.0%. All respiratory symptoms, separately or in combination, as well as medication use were reported most frequently in those with ACO compared to the other groups. Strikingly, we observed a two-fold higher proportion of allergic rhinitis in ACO compared to COPD only.

In this Norwegian population, the prevalence of self-reported ACO was 1.9%, and the corresponding proportion of ACO among those with COPD was 0.56. Participants with ACO generally had the highest proportions of respiratory symptoms compared to asthma or COPD.     

MicroRNA Target Sites as Genetic Tools to Enhance Promoter-Reporter Specificity for the Purification of Pancreatic Progenitor Cells from Differentiated Embryonic Stem Cells

Pluripotent cells hold great promise for cell replacement therapies in regenerative medicine. All known protocols for directed in vitro differentiation of pluripotent cells did not yield pure populations complicating the characterization of the derived cells. In addition, the risk of tumor formation due to residual undifferentiated cells is a serious unresolved problem. In the present study the tissue-specific mouse Pdx1 promoter was used to control the expression of the reporter gene GFP2 in mouse ES cells in order to purify them via FACS during in vitro differentiation. The background fluorescence of transduced ES cells hampered the purification of Pdx1-positive cells due to a contaminating population of partially undifferentiated cells. MicroRNAs (mir) are important regulators of gene expression and were used to enhance promoter specificity during differentiation towards pancreatic progenitor cells. The mouse mmu-mir-294 was found to be mainly expressed during pluripotency, whereas the expression of the mir-302 cluster was increased during early differentiation. Integration of a microRNA target site for the mmu-mir-294 into the lentiviral vector reduced the background fluorescence specifically during pluripotency and permitted re-occurrence of GFP2 expression upon differentiation. A combination of the microRNA target site with the Pdx1 promoter fragment allowed the purification of pancreatic progenitors from differentiated ES cells. This population reflected an early pancreatic progenitor population without other contaminating cell lineages. In conclusion, microRNA target sites are efficient regulatory elements to control transgene expression and to enhance tissue specificity as presented in this study facilitating the sorting and purification of Pdx1-positive pancreatic progenitor cells.     

Surgical strategy in grade II astrocytoma: a population-based analysis of survival and morbidity with a strategy of early resection as compared to watchful waiting

Background

We recently demonstrated a survival benefit of early resection in unselected diffuse low-grade gliomas (LGG). However, heterogeneity within the LGG entity warrants investigation in a homogenous subgroup. Astrocytoma represents the largest subgroup of LGG, and is characterized by diffuse growth and inferior prognosis. We aimed to study the effects of early resection compared to biopsy and watchful waiting in this subgroup.

Methods

Patient data was retrospectively reviewed in two neurosurgical departments with regional referral practice. In one hospital, initial diagnostic biopsies and watchful waiting was favored, while early resections guided with three-dimensional (3D) ultrasound were advocated in the other hospital. This created a natural experiment with patient management heavy influenced by residential address. In the hospitals’ histopathology databases, all adult patients diagnosed with supratentorial LGG from 1998 through 2009 were screened (n?=?169) and underwent blinded histopathological review. Histopathological review concluded with 117 patients with grade II astrocytomas that were included in the present study. The primary end-point was overall survival assessed by a regional comparison.

Results

Early resections were performed in 51 (82 %) versus 12 (22 %) patients in the respective hospitals (p?<?0.001). The two patient populations were otherwise similar. Median survival was 9.7 years (95 % CI 7.5–11.9) if treated in the hospital favoring early resections compared to 5.6 years (95 % CI 3.5–7.6) if treated at the hospital favoring biopsy and watchful waiting (p?=?0.047). No difference in surgical-related neurological morbidity was seen (p?=?0.843).

Conclusions

Early 3D ultrasound guided resections improve survival, apparently without increased morbidity, compared to biopsy and watchful waiting in patients with diffuse World Health Organization (WHO) grade II astrocytomas.     

Circulating KIT D816V mutation-positive non-mast cells in peripheral blood are characteristic of indolent systemic mastocytosis

It is presently accepted that the KIT D816V mutation is detectable in tissues with neoplastic mast cells in most patients with indolent systemic mastocytosis. In this study, neoplastic mast cells were detected in bone marrow, but not in peripheral blood, by flow cytometry in all 25 included cases of indolent systemic mastocytosis. However, the KIT D816V mutation was detected using mutation-specific qPCR in both bone marrow and peripheral blood in all 25 cases, demonstrating for the first time that the KIT D816V mutation is consistently present in non-mast cells in indolent systemic mastocytosis and that these cells are circulating in peripheral blood.     

Effect of subcutaneous suture line and surgical technique on wound infection after saphenectomy in coronary artery bypass grafting: a prospective randomised study

Objective. The aim of the study was to evaluate the impact of an additional subcutaneous suture line on the incidence of postoperative (p.o.) infection at the vena saphena magna harvesting site (VSMHS) after coronary artery bypass grafting (CABG). Methods. Two hundred and forty three patients undergoing CABG were included. Patients in Group A (n?=?119) all operated by one physical assistant (PA) were prospectively randomised into Group A1 (n?=?59) receiving intracutaneous closure suture alone whereas 60 patients (Group A2) received an additional subcutaneous suture line. Group B (n?=?120), operated by surgical residents, served as control population. All patients were due to follow-up at six weeks p.o. Results. Subcutaneous suture did not impact the p.o. infection rate (A2 vs. A1; 4/60 vs. 2/59, n.s.). A significant lower p.o. infection rate was observed in Group A vs. Group B (6/119 (5%) vs. 15/120 (13%) p?<?0.05). Conclusion. Subcutaneous suture did not impact the p.o. infection rate at VSMHS. The infection rate observed in patients operated by an experienced PA was significantly lower than in patients operated by various surgical residents.     

Analysis of the direct cost of surgery for four diagnostic categories of adult spinal deformity

Background contextExisting literature on adult spinal deformity (ASD) offers little guidance regarding an evidence-based approach to care. To optimize the value of medical treatment, a thorough understanding of the cost of surgical treatment for ASD is required.PurposeTo evaluate four clinically and radiographically distinct groups of ASD and identify and compare the cost of surgical treatment among the groups.Study design/settingMulticenter retrospective study of consecutive surgeries for ASD.Patient sampleThree hundred twenty-five consecutive ASD patients treated between 2008 and 2010.Outcome measuresCost data were collected from hospital administrative records on the direct costs (DCs) incurred for the episode of surgical care, excluding overhead.MethodsBased on preoperative radiographs and history, patients were categorized into one of four diagnostic categories of deformity: primary idiopathic scoliosis (PIS), primary degenerative scoliosis (PDS), primary sagittal plane deformity (PSPD), and revision (R). Analysis of variance and generalized linear model regressions were used to analyze the DCs of surgery and to assess differences in costs across the four diagnostic categories considered.ResultsSignificant differences were observed in DC of surgery for different categories of ASD, with surgical treatment for PDS the most expensive followed in decreasing order by PSPD, PIS, and R (p<.01). Results further revealed a significant positive relationship between age and DC (p<.01) and a significant positive relationship between length of stay and DC (p<.01). Among PIS patients, for every incremental increase in levels fused, the expected DC increased by $3,997 (p=.00). Fusion to pelvis also significantly increased the DC of surgery for patients aged 18 to 29 years (p<.01) and 30 to 59 years (p<.01) but not for 60 years or more (p=.86).ConclusionsThere is an increasing DC of surgery with increasing age, length of hospital stay, length of fusion, and fusions to the pelvis. Revision surgery is the least expensive surgery on average and should therefore not preclude its consideration from a pure cost perspective.     

The incidence of caries and white spot lesions in orthodontically treated adolescents with a comprehensive caries prophylactic regimen--a prospective study

The aim of the study was to assess the effect of a comprehensive prophylactic regimen in reducing the incidence of white spot lesions (WSL) and caries during orthodontic treatment. Eighty consecutive patients, scheduled for fixed appliance treatment in both jaws were compared with a non-orthodontic matched-control group. The oral hygiene regimen consisted of brushing two to three times daily, flossing, fluoride rinse, and plaque disclosing tablets. Patients were requested to avoid carbonated soft drinks/acidic juices and candies. The WSL index of Gorelick et al. (Gorelick L, Geiger A M, Gwinnett A J 1982 Incidence of white spot formation after bonding and banding. American Journal of Orthodontics 81: 93-98) was used. Caries were scored according to Amarante et al. (Amarante E, Raadal M, Espelid I 1998 Impact of diagnostic criteria on the prevalence of dental caries in Norwegian children aged 5, 12 and 18 years. Community Dental Oral Epidemiology 26: 87-94). We collected data from all finished cases. It comprised 40 subjects in the orthodontic group (mean age: 13.6 years, range: 12-16 years) and 40 matched controls. The average treatment time was 18 months (range: 9-25 months). The mean increase in WSL index in the orthodontic group was 1.9 and 0.4 in the control group (P = 0.001). The mean increase in dentine caries was 0.5 lesions and 0.7 lesions in the in the orthodontic group and control group, respectively (P = 0.62). Twenty-three per cent of treated patients showed good compliance, 68 per cent moderate compliance, and 9 per cent poor compliance. The mean increase in WSL was 1.0, 1.4, and 3.3 in the good, moderate, and poor compliance group, respectively (P = 0.155). Orthodontically treated patients have significantly higher risk for developing WSL than untreated patients, while there is no difference with respect to development of new dentinal caries lesions. This study showed that a possible relationship between compliance and WSL development existed.     

A review of mercury exposure among artisanal small-scale gold miners in developing countries

Purpose

Extraction of gold using mercury has been a way out of poverty for millions of people in developing countries. Artisanal small-scale gold mining (ASGM) has expanded during the last decades and is often carried out under primitive conditions. Thus, workers in this industry may be exposed to high levels of mercury and suffer from toxic effects from mercury exposure. The objective of this review was to provide an outline of the studies available on elemental mercury exposure among artisanal small-scale gold miners.

Methods

Searching the PubMed and Embase databases, 26 studies with a total of 3,005 exposed subjects and 442 controls across 14 different developing countries were found. Urine mercury levels were used as biomarkers of exposure.

Results

In general, the urine mercury levels were elevated and a considerable proportion of workers had urine mercury levels above existing guidelines. Exposed subjects were stratified into residents, miners, millers, smelters, and refiners, who by work task content were expected to be increasingly exposed to mercury. This group order did show a clear trend of increasing mercury levels. Mercury levels differed substantially between studies. Possible explanations include dissimilarities in gold extraction methods, use of protective devices, and selection of participants.

Conclusions

This review provides evidence that artisanal gold miners and residents of the mining sites are exposed to mercury vapour to an extent where acute and long-term toxic effects of mercury are likely. Interventions aimed at reducing exposure and emission of mercury from ASGM are needed.     

Sex differences in muscular load among house painters performing identical work tasks

Purpose

The present study aimed to estimate possible differences in upper body muscular load between male and female house painters performing identical work tasks. Sex-related differences in muscular load may help explain why women, in general, have more musculoskeletal complaints than men.

Methods

In a laboratory setting, 16 male and 16 female house painters performed nine standardised work tasks common to house painters. Unilateral electromyography (EMG) recordings were obtained from the supraspinatus muscle by intramuscular electrodes and from the trapezius, extensor and flexor carpi radialis muscles by surface electrodes. Relative muscular loads in %EMG_max as well as exerted force in Newton, based on ramp calibrations, were assessed. Sex differences were tested using a mixed model approach.

Results

Women worked at about 50 % higher relative muscular loads than men in the supraspinatus and forearm muscles at all percentiles and in all tasks. Women exerted about 30 % less force in the trapezius muscle at the 50th percentile.

Conclusions

Female house painters had a higher relative muscular load than their male colleagues without exerting more force. The effects of a higher relative muscular load accumulated over years of work may in part explain why musculoskeletal complaints in the upper body occur more frequently among women than men.